“监测-培训-计划”干预模式在血管介入手术围术期中的应用

Application of MTP Intervention Model in Perioperative Period of Vascular Interventional Procedures

目的:探讨采用世界卫生组织倡导的"监测-培训-计划"(MTP)模式对我院血管介入手术围术期抗菌药物干预的效果。方法:以我院2010年第1季度86例血管介入手术作为调研样本,通过MTP模式对心内科血管介入手术围术期抗菌药物的应用情况进行干预,经过4轮MTP循环,取2011年第1季度95例血管介入手术作为干预后的最终样本,比较干预前、后的效果。结果:经过4轮干预,抗菌药物应用率从干预前的100%下降到干预后的84.2%(P<0.05);用药品种前3位由头孢美唑钠、头孢哌酮/他唑巴坦、头孢孟多酯钠更换为头孢唑林、头孢硫脒、头孢美唑钠;术后24h停药病例由0升高到91.3%(P<0.05);平均住院时间由12.6d下降到11.8d;平均总药品费用由8639.8元下降到6825.2元;平均抗菌药物费用由1814.64元下降到84.5元。结论:运用MTP模式对我院心内科血管介入手术围术期抗菌药物的应用进行管理,明显提高了抗菌药物应用的合理性与卫生经济效益。

OBJECTIVE：To study the effects to antibiotics for vascular interventional procedures in perioperative period by ＂Monitoring-Training-Planning＂（MTP） intervention model promoted by WHO.METHODS：86 patients underwent vascular interventional surgery were randomly collected from our hospital in the first quarter of 2010 as baseline study samples.MTP model was used to intervene in antibiotic use in patients undergoing vascular interventional surgery for 4 MTP cycles.95 patients with vascular interventional surgery were collected in the first quarter of 2011 as final study samples after intervention.RESULTS：After 4 MTP cycles,the percentage of antibiotics use was decreased from 100.00% to 84.2%（P0.05）.The top 3 antibiotics were changed from cefmetazole sodium,cefoperazone and tazobactam sodium,cefamandole nafate to cefazolin,cephathiamidine and cefmetazole sodium.Drug withdrawal cases in the latter 24 h increased from 0 to 91.3%（P0.05）.The average hospitalization days decreased from 12.6 d to 11.8 d.The average drug expenses were declined from 8 639.8 yuan to 6 825.2 yuan.The average cost of antibiotics decreased from 1 814.64 yuan to 84.5 yuan.CONCLUSION：Application of MTP interventional mode in management of antibiotics in vascular interventional surgery can significantly improve the rational use of antibiotics and promote economical effectiveness.